Nutritional and Integrative Strategies in Cardiovascular Medicine

Stephen T. Sinatra, Mark C. Houston, Stephen T. Sinatra, Mark C. Houston

• Publisher: CRC Press
• Year: 2022
• Print ISBN: 9780367685010
• eBook ISBN: 9781000559415
• Edition: 2
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Despite decades of aggressive pharmaceutical and surgical interventions, coronary artery disease (CAD) remains the number one killer of both men and women in the Western world. The most important aspect in the treatment of CAD is to focus on prevention. Indeed, prevention is easier than cure and when CAD does present itself, a combination of conventional and alternative methodologies can truly make a difference in people's lives. Building upon its predecessor, Nutritional and Integrative Strategies in Cardiovascular Medicine, Second Edition, provides scientific and clinical insight from leaders in the field of cardiovascular medicine who explore an integrative approach to treating and curing cardiovascular diseases through conventional and non-allopathic methodologies.

Nutritional interventions with both appropriate non-inflammatory diets and targeted nutraceutical supports are simple and basic strategies to prevent as well as help manage CAD and congestive heart failure (CHF). In fact, nutritional strategies in the treatment of CHF have not only afforded patients a better quality of life but increased survival as well. This evidence-based book describes how to integrate nutrition, supplements, lifestyle changes, and medications for improved outcomes in hypertension, dyslipidemia, diabetes, coronary heart disease, congestive heart failure, infectious myocarditis and much more.

Topics include:

• Covid-19: An evidence-based integrative approach to supporting the myocardium
• Metabolic cardiology: An exciting new way to manage heart failure
• Contains information on hypertension and dyslipidemia
• Naturopathic approaches
• Mediterranean diet as the longevity diet of the world
• Value of omega-3s and other fats
• Role of botanicals in the treatment of cardiovascular disease
• Integrative care of the patient in extending quality of life
• Gender-specific medicine – Perhaps a new evolving cardiovascular sub-specialty
• Role of dental disease inflammation and cardiovascular disease
• Environmental toxins and the heart
• Earthing and grounding as an energetic nutrition in healing the heart
• Autophagy and mTOR – the "new medicine" of the future

Nutritional medicine is vitally important in the integrative care of the patient. This book will assist established health professionals as well as students preparing for advanced degrees in healthcare and offer cutting-edge and new information in cardiovascular medicine. It offers simple nutritional supports that can make the difference between not only easing human suffering, but also life and death.

1 Nutrition, the Mediterranean Diet and Selected Supplements for the Prevention and Treatment of Coronary Heart Disease

Mark C. Houston

DOI: 10.1201/9781003137849-1

Contents

• Introduction
• Revolutionizing the Treatment of Coronary Heart Disease and Interrupting the Finite Pathways
• Atherosclerosis, Endothelial Dysfunction and Arterial Stiffness
• Nutrition and CHD
• Specific Diets and Coronary Heart Disease
  • Mediterranean Diet (TMD: Traditional Mediterranean Diet) (PREDIMED Diet)
• Dietary Approaches to Stop Hypertension (DASH) Diets (DASH 1 and 2)
• Dietary Fats
  • Omega 3 Fatty Acids (PUFA)
• Monounsaturated Fats
• Saturated Fatty Acids
• Conclusions and Summary on SFA [14,28,31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56]
• Trans Fatty Acids
• Coconut Oil
• Milk, Milk Products and Peptides
• Whey Protein
• Eggs
• Refined Carbohydrates, Sugars and Sugar Substitutes
• Advanced Glycation End Products (AGEs)
• Protein
  • Vegetarian Diets and Plant-Based Nutrition
• Animal Protein Diets
  • Soy Protein
  • Fish
• Dietary Acid Load and Protein
• Specific Dietary and Nutritional Components and Caloric Restriction
• Caffeine
• Caloric Restriction
• Alcohol
• Gluten
• Nuts
• Dietary Sodium, Potassium and Magnesium
• Summary and Conclusions
• References

Introduction

Cardiovascular disease (CVD) remains the number one cause of morbidity and mortality in the United States [1,2]. The annual cost (direct and indirect) of treatment of CVD is over $320 billion USD [2]. One in every three deaths is a result of CVD, and over 2200 US citizens die from stroke or myocardial infarction (MI) each day [2, 3, 4, 5]. More than 400 coronary heart disease (CHD) risk factors have been defined [2]. Most CVDs can be prevented by addressing behavioral risk factors such as tobacco use, optimal nutrition, obesity, physical inactivity and harmful use of alcohol using population-wide strategies. People with CVD or who are at high risk of CVD (due to the presence of one or more risk factors such as hypertension, diabetes, hyperlipidemia or already-established disease) need early detection and management. Approximately 80% of CHDs can be prevented by optimal nutrition, regular aerobic and resistance exercise, ideal body weight and composition, limited alcoholic intake and avoiding all tobacco products [1]. There are numerous insults to the cardiovascular system, but there are only three finite vascular responses which include inflammation, oxidative stress and vascular immune dysfunction which lead to the atherosclerotic process and plaque, CHD and MI. Coronary heart disease (CHD) remains the cause of the highest mortality in industrialized societies. About 80% of CHDs can be prevented with optimal nutrition, proper exercise, weight management, limited alcohol intake and smoking cessation. Among all of these factors, nutrition provides the basic foundation for the prevention and treatment of CHD in numerous prospective nutrition clinical trials. As nutritional science, nutrigenomic and metabolomic research continues, we will develop a better personalized and precision-based nutritional program to reduce the risk of CHD and myocardial infarction (MI) (Figure 1.1).

FIGURE 1.1 The pathogenesis atherosclerotic plaque formation.

Revolutionizing the Treatment of Coronary Heart Disease and Interrupting the Finite Pathways

Interaction of various insults with cell membranes and endothelial vascular receptors (pattern recognition receptors (PRRs), NOD-like receptors (NLRs), toll-like receptors (TLRs) and caveolae, which contain endothelial nitric oxide synthase (eNOS) and nitric oxide (NO)) determines the cellular internal signaling and vascular responses [2,6, 7, 8] (Figure 1.2).

FIGURE 1.2 Biochemical and biomechanical insults that interact with vascular receptors (pattern recognition receptors, PRRs; NOD-like receptors, NLRs; toll-like receptors, TLRs; and caveolae) to induce the three finite responses of vascular inflammation, oxidative stress and vascular immune dysfunction which lead to endothelial dysfunction and vascular smooth muscle and cardiac dysfunction.

Chronic insults of any type induce inflammatory, oxidative stress and immune responses which become dysregulated and produce damage to the vascular system. In this scenario, the blood vessel becomes an “innocent bystander” to the pathogenic mechanisms, which eventually leads to functional and structural cardiovascular injuries [2]. Numerous scientifically validated nutritional or dietary components and nutraceutical supplements have great promise to reduce the vascular damage [4,8].

Atherosclerosis, Endothelial Dysfunction and Arterial Stiffness

Atherosclerosis, endothelial dysfunction (the earliest vascular abnormality) and arterial stiffness of small arteries begin early in life [9, 10, 11, 12] (Figure 1.3).

FIGURE 1.3 Atherosclerosis progression. The initial lesion progresses to a fatty streak, and then to an intermediate lesion, atheroma, and fibroatheroma, a complicated lesion prone to rupture and thrombosis.

The consumption of excessive dietary sodium chloride (NaCl), refined carbohydrates (CHO), sugars, starches, trans fatty acids (TFAs) and some, but not all, saturated fatty acids (SFAs) will promote glucotoxicity, triglyceride toxicity, vascular metabolic endotoxemia, inflammation, oxidative stress and vascular immune dysfunction that may persist long after the initial insult. This may also result in exaggerated responses (through metabolic memory) with repeated or chronic nutritional insults [6,9, 10, 11, 12].

Nutrition and CHD

Targeted nutrition in combination with other lifestyle changes is a foundational recommendation for the reduction of CHD risk. National and international nutritional guidelines are still evolving as new science, nutrigenomic and metabolomic studies are published. There are many recent clinical trials that demonstrate improved CHD outcomes related to nutrition (Table 1.1) [13,14].

TABLE 1.1 Summary of Nutrition, Nutrients and Daily Intake

Nutrient	Daily Intake
Diets that benefit cardiovascular health
Mediterranean diet and MD + ALA
DASH 1 and 2
Vegetarian diet Potential for nutrient deficiencies, including vitamin B12, vitamin D, omega 3 fatty acids, iron, calcium, carnitine, zinc and protein
Paleolithic diet
Caloric restriction and intermittent fasting
Low ages
Alkaline diet No definitive results but appears in line with DASH and TMD
Fats	Less than 35% total caloric intake
SFA LCFA and MCFA have variable effects, with LCFA having a higher risk; SCFA are neutral	<7%–9% of total diet Replace with PUFA or MUFA
Coconut oil No recommendation for prevention or treatment of CHD or CVD, but it is a possible substitute for high glycemic carbohydrates in low amounts
Trans fat	Avoid trans fat
PUFA Omega 3 fatty acids Opt for balanced formulation with DHA, EPA, GLA, and gamma-delta tocopherols	Omega 3 to omega 6 ratio at 4:1 >1g of EPA + DHA per day 1.1 g/day for women 1.6 g/day for men ~2% total daily calories
MUFA [165]: Extra-virgin olive oil	50 g/day
Diet elements
Animal protein Avoid processed red meat Aim for lean cuts
Fish Choose fish with high omega-3 content and low mercury levels	1–2 servings/week 20 g/day
Nuts	>5 servings/week; 28 g/day
Vegetables and fruits Dark leafy greens have the strongest effect on CHD risk	200 g–800 g/day
Milk and milk products Intake has an inverse association with CVD
Eggs No association with increased risk, except possibly for diabetics Special recommendation for diabetics	6–12 eggs per week as part of a healthy cardiovascular diet
Refined carbs, sugar and sugar substitutes	Reduce or eliminate from diet
Alcohol	1–2 drinks/day for women 2–4 drinks/day for men
Isolated nutrients and nutraceutical supplements
Curcumin
Cinnamaldehyde (cinnamon)
Sulforaphane (broccoli)
Resveratrol
Luteolin
Quercetin
Caffeine Different effect on fast metabolizers compared to slow metabolizers	Caffeinated coffee for slow metabolizers 59 and younger <2–3 cups Older than 59 < 1 cup
Soy protein	15–30 g/day
Whey protein	20 g/day
Gluten No link even in those with celiac disease Choose 100% whole grains
Sodium	Low sodium–potassium ratio
Potassium	4.7 g/day, preferably f...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Table of Contents
• Introduction
• Editors
• Contributors
• Chapter 1 Nutrition, the Mediterranean Diet and Selected Supplements for the Prevention and Treatment of Coronary Heart Disease
• Chapter 2 Coronary Artery Disease: The Impact of the Mediterranean Cuisine, Targeted Nutritional Supplements and Their Relationship to Autophagy/mTOR
• Chapter 3 Naturopathic Medicine and the Prevention and Treatment of Cardiovascular Disease
• Chapter 4 Marine-Derived Omega-3 Fatty Acids and Cardiovascular Disease
• Chapter 5 Nutrition and Nutritional Supplements in the Management of Dyslipidemia and Dyslipidemia-Induced Cardiovascular Disease
• Chapter 6 The Role of Nitric Oxide Supplements and Foods in Cardiovascular Disease
• Chapter 7 The Treatment of Hypertension with Nutrition, Nutritional Supplements, Lifestyle and Pharmacologic Therapies
• Chapter 8 Metabolic Cardiology: Management of Congestive Heart Failure
• Chapter 9 Cardiovascular Disease in Women
• Chapter 10 Hormones and Cardiovascular Disease
• Chapter 11 The Heartbreak of Wheat-Related Disorders: Wheat, Gluten and Cardiovascular Disease
• Chapter 12 The Role of the Gut Microbiome in Cardiovascular Disease
• Chapter 13 Environmental Toxins and Cardiovascular Disease
• Chapter 14 Dental Disease, Inflammation, Cardiovascular Disease, Nutrition and Nutritional Supplements
• Chapter 15 COVID-19: An Evidence-Based Integrative Approach to Disease Management
• Chapter 16 Lymphstasis, Inflammation and Atherogenesis – Connecting the Dots
• Chapter 17 Vitamin G. Grounding as Energetic Nutrition and Its Role in Oxidative Defense and Cardiovascular Disease
• Chapter 18 The Role of Botanicals in Cardiovascular Health
• Chapter 19 Depression, Anxiety, Stress, and Spirituality in Cardiovascular Disease
• Index